kottke.org posts about vaccines

The development of vaccines against infectious diseases is among the greatest of human accomplishments and has saved ten of millions of people from dying. And yet some are still hung up on their side effects (and also the widely disproved and debunked fraudulent claim that vaccines cause autism). In this video, Kurzgesagt looks at how vaccines work and compares the impact of their side effects (minuscule) to the potential effect of the diseases they protect against (children dying).

The title of this video is “The Side Effects of Vaccines - How High is the Risk?”, which seems like it’s maximized for clicks and to spread amongst anti-vaxxers on social media. I wish it had a more accurate title — something like “The Absurdly Low Risk of Vaccine Side Effects” or maybe “Vaccines. And Now My Kids Don’t Die.” — but perhaps positioning it this way is a good strategy to get folks who may not be quite so radicalized to watch it.

Tetanus, popularly called “lockjaw,” is a serious illness, fatal in 10 percent of cases in North America and a larger percentage elsewhere. But despite the popular perception of its association with cutting oneself on a rusty nail, the disease has nothing to do with iron oxide, or rust:

Rather, tetanus is a product of the bacteria Clostridium tetani, which is in dirt, dust, and feces—in other words, everywhere. It can enter your body through puncture wounds, yes, but also through superficial cuts, bug bites, surgical procedures, and any other rupture to your skin. It can come from stepping on a rusty nail, or tending the soil in your garden. That’s why it’s so essential to track your booster shots: You need one every decade, not just when you rip your palm open on a rusty chain link fence. Waiting for a classic tetanus injury won’t work when anything could, in theory, be a tetanus injury.

If the bacteria enter your body and you aren’t up-to-date on your vaccinations, the tiny invaders begin to multiply rapidly. This incubation period, which lasts between three and 21 days, according to the CDC, is symptom free. But as the bacteria begin to die inside you, they form a neurotoxin that attacks the nervous system. Specifically, it inhibits the chemical GABA, which regulates muscle contractions. The result is a body-wide state of tension, from lockjaw in your face to uncontrollable arching spasms in your back to permanently-curled toes.

Luckily, here as elsewhere, tetanus vaccines (a series of three shots and a booster every ten years) work. Get those shots up to date and mind those cuts, no matter where they came from.

Roald Dahl’s oldest daughter Olivia died from the measles when she was seven years old. She died because there wasn’t a reliable measles vaccine then, and in this heartfelt letter he wrote years later, Dahl wants everyone to know that there is such a vaccine now.

Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

‘Are you feeling all right?’ I asked her.

‘I feel all sleepy,’ she said.

In an hour, she was unconscious. In twelve hours she was dead.

The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her.

On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles. I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.

I feel so tired when I think about parents not vaccinating their children against easily preventable fatal diseases. It’s child abuse and the kids know better! Here’s a tweet from Erin Faulk sharing some screenshots of teens asking how they can get vaccinated over their parents’ objections.

Bill: If we could show you only one number that proves how life has changed for the poorest, it would be 122 million — the number of children’s lives saved since 1990.

Melinda: Every September, the UN announces the number of children under five who died the previous year. Every year, this number breaks my heart and gives me hope. It’s tragic that so many children are dying, but every year more children live.

Bill: More children survived in 2015 than in 2014. More survived in 2014 than in 2013, and so on. If you add it all up, 122 million children under age five have been saved over the past 25 years. These are children who would have died if mortality rates had stayed where they were in 1990.

Melinda: And if you want to know the best deal within the deal — it’s vaccines. Coverage for the basic package of childhood vaccines is now the highest it’s ever been, at 86 percent. And the gap between the richest and the poorest countries is the lowest it’s ever been. Vaccines are the biggest reason for the drop in childhood deaths.

Melinda: They’re an incredible investment. The pentavalent vaccine, which protects against five deadly infections in a single shot, now costs under a dollar.

Bill: And for every dollar spent on childhood immunizations, you get $44 in economic benefits. That includes saving the money that families lose when a child is sick and a parent can’t work.

Horseshoe crab. We all owe a debt of gratitude to the helmet-shaped horseshoe crab, whose ancestors date back 450 million years. From vaccines to needles to pacemakers, any IV drug or medical equipment that will come in contact with the human body must first be safety-checked using a test that comes from a clotting compound in the crab’s blood. This compound can detect even the smallest amount of deadly bacteria and is sensitive enough to isolate a threat equivalent to the size of a grain of sand in a swimming pool.

Vaccines. Immunization is one of the most important public health achievements in human history. Vaccines helped eradicate smallpox globally and eliminate polio in the United States. The introduction of effective vaccines has also drastically reduced deaths from measles, diphtheria, rubella, pertussis (“whooping cough”) and other diseases that sickened hundreds of thousands of Americans in the early 20th century.

American Cheese. Food processing was actually developed to make food safer. Milk is pasteurized to kill harmful organisms, and canning and freezing foods such as meats, fruits and vegetables helps them last longer. But the food industry has taken processing well beyond these early origins. Often, to extend a food’s shelf life, manufacturers increase fats, sugars, and salt and add in chemical flavorings, emulsifiers, and other additives — taking foods that could have been healthy and making them much less so.

Pap smear. Since its introduction in 1955, the Pap smear has reduced death from cervical cancer by more than 60 percent. Invented by Dr. Georgios Papanikolaou, the Pap smear is a diagnostic procedure in which a health-care professional swabs a cell sample from the cervix and sends it to a lab to see if any of the cells are malignant. Before the invention of the Pap smear, cervical cancer was one of the leading causes of death for women of childbearing age in the United States. Today, it comes in at number 14 on the list of cancers found in women.

Spittoons. Spittoons were developed centuries ago as receptacles for spitting — think ashtrays for saliva. These brass or even porcelain repositories were everywhere: In homes, train stations, saloons and even the U.S. Congress. They were meant for men to dispose their chewing tobacco and the abundant phlegm that accompanied the habit. Convenience turned to concern in the late 19th century when a global tuberculosis epidemic took hold and scientists realized that spittoons might actually spread diseases. Some argued that when people spat in the general direction of a spittoon and missed the target, they caused a greater health threat than if the spittoon hadn’t been there at all.

Neoantigen vaccines use the DNA from a cancer patient’s own tumor to, hopefully, eradicate the cancer.

For some 50 years, cancer biologists have tried to incite the immune system to attack cancer by targeting molecules that commonly stud the surfaces of malignant cells. These “antigens” act as homing beacons that immune cells find and lock onto (much as antigens on viruses attract the immune system, the basis for preventive vaccines such as that for measles).

Trouble is, normal cells sometimes sport the same antigens as tumors, and the immune system is programmed not to attack antigens found on healthy cells. As a result, revving up the immune system to target common tumor antigens hasn’t worked, leading to a number of failed experimental cancer vaccines.

That led biologists to a different approach: siccing the immune system on antigens found only on cancer cells — and only on the cancer cells of a single patient. “It’s highly unlikely that any two patients have the same neoantigens,” said Dr. Catherine Wu of Boston’s Dana-Farber Cancer Institute. “That’s why we have an opportunity to make cancer vaccines truly personalized, loaded with patient-specific neoantigens.”

Host Hank Green of the SciShow looks at the anti-vaccination movement from a scientific perspective: why are US parents growing less likely to vaccinate their children?

In psychology, the search for these explanations is called “Explanatory Attribution” and different people have different “explanatory styles”. Some people are more prone to blame themselves, while others search for an external event to blame. But one thing is clear: we are very bad at not blaming anything. It’s not surprising that parents of children with autism, especially parents who notice a sudden loss of previous development, will search for a possible cause. And when the most significant recent event in the health of the child was a vaccination, as can be said for many moments in the life of a young American, we might identify that as a potential cause and deem that link worthy of further examination.

Now this, is completely logical. The problem is that over a dozen peer-reviewed papers have found no correlation between autism and the MMR vaccine, or any other vaccine for that matter. And yet, when you Google vaccines and autism, a fair number of the results claim that there is a link between the two, and that that link is being covered up either by the government or by big corporations. A parent, already experiencing frustration with the medical community’s inability to tell them why this thing has happened to their child, will, on the internet, find a vibrant community of similarly frustrated people who share their values and experiences. These communities are full of anecdotes that draw connections between vaccines and autism. And so, unsurprisingly, some people become convinced that they have found the reason for their child’s disability.

Once their mind has been made up, confirmation bias sets in. Confirmation bias is simply our tendency to more readily, and with less scrutiny, accept information, anecdotes, and world views that confirm our existing beliefs. And, again, it is a completely normal thing that every person does. Indeed, trying to convince someone that a previously held belief is incorrect has been proven to actually increase their affinity for that idea. And so a community is born, and the safety of vaccines is called into question. And once the procedure for getting a vaccine goes from the doctor telling you that it is now time for a vaccine — and 99% of parents agreeing because that person went through medical school — to it being a question to ponder, vaccination rates will go down.

Administrators at Palm Desert High School in California have banned 66 students who never got measles vaccinations.

“I think some parents see it as a personal choice, like homeschooling. But when you choose not to vaccinate, you’re putting other children at risk.” From WaPo: Why this baby’s mom is so angry at the anti-vaxxers.

“I respect people’s choices about what to do with their kids, but if someone’s kid gets sick and gets my kid sick, too, that’s a problem.” A Marin County father has demanded that his district keep unvaccinated kids out of school.

Today’s Google Doodle honors Jonas Salk on what would have been his 100th birthday. Salk developed the first successful polio vaccine in 1955 and was hailed as a hero for it.

On April 12, 1955, Dr. Thomas Francis, Jr., of the University of Michigan, the monitor of the test results, “declared the vaccine to be safe and effective.” The announcement was made at the University of Michigan, exactly 10 years to the day after the death of President Roosevelt. Five hundred people, including 150 press, radio, and television reporters, filled the room; 16 television and newsreel cameras stood on a long platform at the back; and 54,000 physicians, sitting in movie theaters across the country, watched the broadcast on closed-circuit television. Eli Lilly and Company paid $250,000 to broadcast the event. Americans turned on their radios to hear the details, department stores set up loudspeakers, and judges suspended trials so that everyone in the courtroom could hear. Europeans listened on the Voice of America. Paul Offit writes about the event:

“The presentation was numbing, but the results were clear: the vaccine worked. Inside the auditorium Americans tearfully and joyfully embraced the results. By the time Thomas Francis stepped down from the podium, church bells were ringing across the country, factories were observing moments of silence, synagogues and churches were holding prayer meetings, and parents and teachers were weeping. One shopkeeper painted a sign on his window: Thank you, Dr. Salk. ‘It was as if a war had ended’, one observer recalled.”

Because of Salk’s vaccine and subsequent vaccines, the US has been polio-free since 1979.

So, as part of a two-patient clinical trial, doctors at the Mayo Clinic injected Erholtz with 100 billion units of the measles virus — enough to inoculate 10 million people.

Her doctor said they were entering the unknown.

Five minutes into the hour-long process, Erholtz got a terrible headache. Two hours later, she started shaking and vomiting. Her temperature hit 105 degrees, Stephen Russell, the lead researcher on the case, told The Washington Post early Thursday morning.

“Thirty-six hours after the virus infusion was finished, she told me, ‘Evan has started shrinking,’” Russell said. Over the next several weeks, the tumor on her forehead disappeared completely and, over time, the other tumors in her body did, too.

The cancer of the other person in the trial was unaffected and larger randomized trials still have to be performed, but this is encouraging news. Between this and the remission of cancer using HIV, it looks like viral therapy has a real shot at being a powerful weapon in fighting cancer.

America experienced the height of polio in the 1940s and ’50s, when about 35,000 people became disabled every year. Fear and panic spread and parents were known to warn their children to not drink from public water fountains, avoid swimming pools and stay away from crowded public places like movie theaters. Perhaps the most famous case of polio in America was Franklin Delano Roosevelt, the first president with a significant physical disability.

The development of the Salk and Sabine vaccines helped lead to eradication of polio in the United States in 1979. In India, too, vaccination was critical.

“There were three keys to our success,” Kapur says. “Immunize, immunize and immunize.”

As healthy as my lifestyle seemed, I contracted measles, mumps, rubella, a type of viral meningitis, scarlatina, whooping cough, yearly tonsillitis, and chickenpox. In my 20s I got precancerous HPV and spent six months of my life wondering how I was going to tell my two children under the age of 7 that Mummy might have cancer before it was safely removed.

This is the part that really gets to me: Parker wasn’t vaccinated but was given so many antibiotics for her childhood illnesses that she became immune to them! [Hair-tearing-out noise]

My two vaccinated children, on the other hand, have rarely been ill, have had antibiotics maybe twice in their lives, if that. Not like their mum. I got so many illnesses requiring treatment with antibiotics that I developed a resistance to them, which led me to be hospitalized with penicillin-resistant quinsy at age 21 — you know, that old-fashioned disease that supposedly killed Queen Elizabeth I and that was almost wiped out through use of antibiotics.

Update: Slate has corrected the passage above, taking out the part about Parker’s resistance to antibiotics. It now reads:

My two vaccinated children, on the other hand, have rarely been ill, have had antibiotics maybe twice in their lives, if that. Not like their mum. I got many illnesses requiring treatment with antibiotics. I developed penicillin-resistant quinsy at age 21 — you know, that old-fashioned disease that supposedly killed Queen Elizabeth I and that was almost wiped out through use of antibiotics.

People do not develop antibiotic resistance, microorganisms do. I regret the idiotic error and tearing out my hair. (thx @chrismize)

What if there were a new class of wonder drugs for children that prevented some of the worst diseases in history with very limited side effects…would you take them? Some people don’t “trust” that wacky “science” though.

What’s so confounding is that many of the parents requesting exemptions for their children cite specious, disproven fears — such as that the vaccine could cause autism — many of which were based on a fraudulent, retracted study or fringe research published in non-peer-reviewed journals. And the rest of the country hasn’t been as successful as Massachusetts in containing measles infections. Earlier this year, an intentionally unvaccinated 17-year-old from Brooklyn, New York, was infected with measles while on a trip to the United Kingdom. Because he lived in a community with a large number of other deliberately unvaccinated children, the virus quickly spread. By the time the outbreak was contained, 58 people had been infected — making it the largest outbreak in the country in more than 15 years. Nationwide, the Centers for Disease Control and Prevention reported 159 total cases between January and August, which puts 2013 on track to record the most domestic measles infections since the disease was declared eliminated from the United States in 2000.

An article from a mother who was anti-vaccine until her daughter (and then the rest of the family) got the whooping cough. And still she feels “funny” about vaccination.

And yet I still wondered about that list of things that I would now, I suppose, have to surrender to and immunise my child against. Polio, for one — a couple of my parents’ pensioner friends still carry the limp left by their childhood polio, but none of my friends do, because it isn’t around any more. And diphtheria — what was that, even? I knew it had killed one of Queen Victoria’s daughters, but that wasn’t our reality.

The reason it wasn’t our reality was, of course, due to a continuous programme of immunisation. Duh. Diphtheria is a disease that still kills one in five infants it meets, even if they get treatment, their necks swelling up until they can no longer breathe. I have now seen a picture of a child whose neck was ravaged by diphtheria, bloated like a foie gras goose about to burst. I wish I could unsee it.

In June 2007 Jenny McCarthy began promoting anti-vaccination rhetoric. Because of her celebrity status she has appeared on several television shows and has published multiple books advising parents not to vaccinate their children. This has led to an increase in the number of vaccine preventable illnesses as well as an increase in the number of vaccine preventable deaths.

Indigo children is a term used to describe children who are believed to possess special, unusual and sometimes supernatural traits or abilities. The term is pseudoscientific. The idea is based on New Age concepts developed in the 1970s by Nancy Ann Tappe and further developed by Jan Tober and Lee Carroll. The concept of indigo children gained popular interest with the publication of a series of books in the late 1990s and the release of several films in the following decade. A variety of books, conferences and related materials have been created surrounding belief in the idea of indigo children and their nature and abilities. The interpretations of these beliefs range from their being the next stage in human evolution, in some cases possessing paranormal abilities such as telepathy, to the belief that they are more empathic and creative than their peers.

For Allan LaReau of Kalamazoo, Mich., and his 11 colleagues at Bronson Rambling Road Pediatrics, who chose in 2010 to stop working with vaccine-refusing families, a major factor was the concern that unimmunized children could pose a danger in the waiting room to infants or sick children who haven’t yet been fully vaccinated.

In one case, an unvaccinated child came in with a high fever and Dr. LaReau feared the patient might have meningitis, a contagious, potentially deadly infection of the brain and spinal cord for which a vaccine commonly is given. “I lost a lot more sleep than I usually do” worrying about the situation, he said.

“You feel badly about losing a nice family from the practice,” added Dr. LaReau, but families who refused to vaccinate their kids were told that “this is going to be a difficult relationship without this core part of pediatrics.” Some families chose to go elsewhere while others agreed to have their kids inoculated.

Jenny McCarthy just won’t call it quits on the whole vaccines cause autism thing. Cause she’s a mom! And moms love their children! And are strong! QED. And of course this was published by Huffington Post, the blog equivalent of Jenny McCarthy.

An investigation published by the British medical journal BMJ concludes the study’s author, Dr. Andrew Wakefield, misrepresented or altered the medical histories of all 12 of the patients whose cases formed the basis of the 1998 study — and that there was “no doubt” Wakefield was responsible.

“It’s one thing to have a bad study, a study full of error, and for the authors then to admit that they made errors,” Fiona Godlee, BMJ’s editor-in-chief, told CNN. “But in this case, we have a very different picture of what seems to be a deliberate attempt to create an impression that there was a link by falsifying the data.”

The debate is essentially over and the final word is in: vaccines do not cause autism. The results of a rigorous study conducted over several years were just announced and they confirmed the results of several past studies.

Basically, the final two groups that were studied consisted of 256 children with ASD [autism spectrum disorders] and 752 matched controls. One very interesting aspect that looks as though it were almost certainly placed into the experimental design based on concerns of anti-vaccine advocates like Sallie Bernard is a group of children who underwent regression. Basically, the study examined whether there was a correlation between ASD and TCV [thimerosal-containing vaccines, i.e. mercury-containing vaccines] exposure. It also examined two subsets of ASD, autistic disorder (AD) and ASD with regression, looking for any indication whether TCVs were associated with any of them. Regression was defined as:

“the subset of case-children with ASD who reported loss of previously acquired language skills after acquisition.”

Also, when adding up total thimerosal exposure, the investigators also included any thimerosal exposure that might have come prenatally from maternal receipt of flu vaccines during pregnancy, as well as immunoglobulins, tetanus toxoids, and diphtheria-tetanus. In other words, investigators tried to factor in all the various ideas for how TCVs might contribute to autism when designing this study.

So what did the investigators find? I think you probably know the answer to that question. They found nothing. Nada. Zip. There wasn’t even a hint of a correlation between TCV exposure and either ASD, AD, or ASD with regression:

“There were no findings of increased risk for any of the 3 ASD outcomes. The adjusted odds ratios (95% confidence intervals) for ASD associated with a 2-SD increase in ethylmercury exposure were 1.12 (0.83-1.51) for prenatal exposure, 0.88 (0.62-1.26) for exposure from birth to 1 month, 0.60 (0.36-0.99) for exposure from birth to 7 months, and 0.60 (0.32- 0.97) for exposure from birth to 20 months.”

The last result is a bit of an anomaly in that it implies that exposure to TCVs from birth to 1 month and birth to 7 months actually protects against ASD. The authors quite rightly comment on this result thusly:

“In the covariate adjusted models, we found that an increase in ethylmercury exposure in 2 of the 4 exposure time periods evaluated was associated with decreased risk of each of the 3 ASD outcomes. We are not aware of a biological mechanism that would lead to this result.”

So get your kids (and yourselves) vaccinated and save them & their playmates from this whooping cough bullshit, which is actually killing actual kids and not, you know, magically infecting them with autism. Vaccination is one of the greatest human discoveries ever — yes, Kanye, OF ALL TIME — has saved countless lives, and has made countless more lives significantly better. So: Buck. Up.